| NPI | 1750633103 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1936) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2012030550) |
| Enumeration Date | 2012-10-10 |
| Last Update Date | 2014-07-15 |